DRIVING and BREAST AUGMENTATION
By lcherup on May 5, 2010
I love to see a patient drive to her first breast augmentation post-op visit, ususally on POD #2. That tells me she is doing well, pain is under control, we probably have no complications. HAVE NO DOUBT, however, that driving and recent surgery is problematic. To be very brutal, if you are stopped by the police for a driving violation, or just happen to be involved in another person’s accident by no fault of your own, AND YOU HAVE Percocet, Ambien, Xanax, Vicodin or any other restricted substance in your system, YOU WILL LOSE YOUR LICENSE even if the surgeon prescribed these meds. Have no doubt. So, you should drive when 1. You can drive without pain meds for at least 12 hours prior to getting in the car. 2. You can anticipate an accident and have the body strength and agility to swerve, accelerate, and brake. 3. You are responsible for only yourself in the car. Thus, I tell my patients : 1. Drive on POD#2 if you can get by on Tylenol only (remember NO NSAIDS). 2. Drive only yourself, get someone else to take the daughter to dance or the little guy to lacrosse. 3. Do not drive far, no trips to take the kids back to college. Please read the augmentation and exercise blog.
Tuberous Breasts
By lcherup on May 3, 2010
It’s kind of sad when you have breasts that just don’t compliment your body, and it’s even more sad when your breasts do not have an optimal shape, and in fact are TUBEROUS. Tuber, or like a gourd, refers to a breast shape that is developmentally abnormal, but not infrequent. The breast tissue is not present all over the chest, but in fact grows from a narrow base, and centrally herniates into the base of the nipple-areola complex (NAC). This results in a projecting, often droopy, narrow breast without a nice round or even conical shape. I mention conical because good plastic surgeons try to transform the breast into one of these shapes with augmentation and periareolar mastopexy. If you have tuberous breasts, please be open-minded to the surgeon who recommends that both procedures will be necessary to give you a good correction of the tuberous deformity. Look at the category tuberous on my website, and see how volume in the lower pole, rounding out the breast, and elevating and reducing the NAC brings the breast to normalcy. A big problem requires a big solution, multi-focused and well-executed. I like anatomic- shaped implants for this problem, and later down the road after the new shape is established, a patient can be converted to round silicone implants if she wishes.
EXERCISE AFTER AUGMENTATION
By lcherup on April 10, 2010
I was the worst after my first breast augmentation. I really wanted to get back to exercising. Maybe that is why I got such BAD capsular contracture after the first round, and NONE after the second. In general, any good surgeon will perform a submuscular placement of your first set of implants, and upper body motion will increase bleeding, swelling and capsular contracture. I love John Tebbetts MD, my mentor, but I completely disagree with him when he has his patients go back to full activity the next day after surgery. Here is what I would do: The night of surgery – Sit on the couch with legs elevated, your back propped up on 2 pillows at the end of the couch. Walk around the house, get yourself an ice tea. Sleep in a similar fashion; do not roll onto your right or left side. Post-op day #1 – Move around, talk a 15 minute walk outside and swing your arms ever so gently. Sleep the same way. POD #2 – Hopefully seeing the surgeon, dressings changed, shower after you are home and have had lunch. Warm, not hot water. Do not drink alcohol with your pain pills. If you want a glass of wine, forego the Percocet. POD #3- Take a 1 mile walk around your high school track, shower, keep the arms no higher than your shoulders. POD #4 – Do the sitting stationary bike at the gym, do not grab the handle bars. POD #5 – Lift weights at the gym with your legs, do 25-50 gentle crunches with arms on the mat. POD #6 – Do some twisting at the waist, keep arms at your sides. POD #7 – Gently jogging for 1 mile is OK in a great sports bra, probably the one you’ve been wearing all along this past week. Walk all you want. Remember during all this time – DO NOT take ibuprofen, aspirin, Vitamin E, fish oil or the 3 G’s – gingko, garlic or glucosamine chondroitin. POD #8 and Week #2- Repeat the above. Don’t eat a lot, just protein, veges and water. Walk, jog a little. You will stay thin. POD#14 – Sutures out, take a jog in a good bra. POD #15- Start doing biceps and rowing. Gentle swimming is OK. Do NOT do tennis, racquetball until week 6. Do not play golf til week 4. Putting is okay on Day #4.
Protect the patient and the plastic surgeon
By lcherup on February 2, 2010
I have had to institute a number of actions to protect the patient’s interests and my own.
First, we like to make it hard to schedule, and hard to cancel. I really don’t want patients who quickly agree to surgery, and then go home and change their mind. It is a very rare event when I allow patients to consent to surgery after only a first visit. Even patients who travel far for the first consultation, I encourage to go home and think about it. I got this idea from the guy who trained me, Dr. Thomas Krizek. Google him.
Second, we charge patients $300 to postpone, and then reschedule a surgery. The reason why is, it screws up our scheduling with our OR staff, anesthesia, implants, drug orders, etc. It costs $900 AN HOUR to man our multi-specialty surgery center. We have employees who are scheduled months in advance. I cannot yank someone off the sidewalk to fill 3 hours because a patient cancelled 3 days ago becaue her motherinlaw is in the CCU. We of course understand patients’ constraints, but they must understand what we bring to the table to pull off a surgery.
Third, because we are performing aesthetic plastic surgery, and insurance does not pay for post-op care, we frequently have to rely on family members to help in the post-op period. I have husbands that I should rent out to other patients. My patient J’s husband is a doll. He invented a tummy -tuck dressing that is marvelous!! On the other hand, I have another patient who had 3 friends sign up for duty, and NONE panned out. I had to admit her to our local hospital for 4 days, for routine post-op care. I am thinking of developing a consent and contract to obligate the care-giver. Otherwise patients have to be responsible for professional care.
Labiaplasty Part II
By lcherup on October 22, 2009
In general, the female perineum, which includes the vulva (labia majora and minora, and clitoris), perineal body (muscle between the vagina and anus), the vagina, and the anus, should look “normal” to a woman. Enlargement or stretching of any of these tisues can lead to sexual dysfunction, difficulties with hygiene, and a less than feminine appearance. With menopause comes thinning and atrophy of the structures. Plastic surgeons, in general, want to leave the vaginal reconstruction to the gynecologists, and usually confine themselves to repairing the labia major, labia minora and the clitoral hood. These structures can be altered by shortening them, and also by filling them out to a more plump, youthful shape, with fat. Various techniques have been described. I believe those that preserve the most sensation, and utilize scars that are the LEAST visible, (notice I did not say completely invisible to all observers), should be employed. Suffice it to say, when normal pubic hair grows over most surfaces, NO scars can be seen. But with today’s trend for no hair on the perieum, no scars is a very tall order to meet.
Labiaplasty Part I
By lcherup on October 5, 2009
On some level, the aesthetic appearance of the female genitalia deserves as much consideration as the aesthetic appearance of any other part of the body. Unlike the treatises that have been published on the principals of breast, eyelid and facial plastic surgery, there are no textbooks on perineal (that which encompasses the labia, clitoris and vagina) rejuvenation. It is a fairly new subject. The articles that have been written fall mostly in the gynecological literature, with very few in the plastic surgery literature. Plastic surgeons , in general, would like to learn from their GYN colleagues, but don’t trust them because, we believe, they do not consider sensation, nerve and arterial supply, and tissue viablilty as seriously as we do. Therefore, we are hesitant to experiment with unproven techniques, and would like to stick with basic principals of tissue rearrangement and healing. AT FIRST, DO NO HARM.
Plastic surgery and anesthesia
By lcherup on April 30, 2009
The kind of anesthesia and how smoothly the patient moves through it can either make or break a good plastic surgery operation and its final result. When I had a rhinoplasty in 1985, one year before I got pregnant with my first child, I had 2 days of post-op nausea and vomiting, and the bruising and swelling in my face practically ruined the good work that Dr. Musgrave did. I do not have to tolerate such a situation for my patients now. Our well-trained nurse anesthetists and anesthesiologists have drugs so superior, so fast-acting and resolving, that very few of our patients have significat nausea post-op. Furthermore, I inject almost all patients with some Marcaine post-op, an anesthetic that lasts for 6 hours so they can get home and get some food in their tummy, get on the couch, and can take a Percocet before stronger pain arrives.
The unfortunate situation is that there is a terrible disconnect between what we can do for patients and what insurance will pay for. Anesthesia groups have become administrative and financial conglomerates that demand fairly high salaries for their employees and we in Pennsylvania have suck-ass poor insurance payment by insurance providers. It would be better if patients just paid for all of their anesthesia in cash. Their anesthesia care would be better, and it is for my aesthetic surgery patients who do just that. .
Complications after surgery
By lcherup on March 14, 2009
I have a big problem as a doctor – I take complications very seriously and personally. I always think it is my fault. I forget that objectively I spent 11 years after college learning that the human body is a frail, faulty creature and sickness happpens to it, especially after surgery. Patients have trouble interpreting their symptoms, their healthy past-history gets in the way of realizing that a problem illness is befalling them after surgery. Most problems can be ‘Nipped in the bud” early, and prevented from becoming big ones. I hate it when communications betweeen me and the patient prevent that from happpening. I have recently started calling all my post-op patients for at least 2 days after their surgeries, and I want to talk to THE patient, not their spouse or other caregiver. I find that I can’t count on anyone else to hear things correctly. My nurses do a great job relaying info to me, but I have to be the one to interpret it. I really wonder how doctors take care of their patients when other partners are rendering some of the post-op care. The bottom line is that the patient HAS to take some responsibility and try to accurately relay info to me so I can interpret it seriously and effectively. WE don’t really want complications, and if we get them, we want to deal with them quickly. They are an expected and normal part of post-op course, except in my mind. I have to keep remembering that for my own sanity.
Why aesthetic surgery costs a lot
By lcherup on January 25, 2009
Most patients looked surprised when they see the price tag for aesthetic surgery. The truth is – aesthetic, or cosmetic surgery costs the same as reconstructive surgery – the patient just doesn’t know the costs. The surgical fees include (are you ready?): the cost of medical supplies, the staff salaries, the building rent, the insurances to cover the building and the doctor’s malpractice to defend himself against false claims; the cost of staff benefits, like health insurance, dental, short-term disability; dictation fees to outside vendors, fire protection, elevator maintenance, cleaning companies, office supplies, the cost of going to meetings to maintain CME, credit card processing fees, bank loans, advertising, membership fees to belong to hospitals and professional organizations… shall I go on? Patients think that their paid fees go right in the doctor’s pocket – if that were only true, I would work 1/8th as hard. Do the math.
Surgery performed on relatives and friends
By lcherup on January 13, 2009
Today I did a facelift on one of my nurses, a very special one that has been with me for 18 years. She takes good care of herself, and it was a pleasure to try and make her look even better. I get the BEST results on people I know. I try so hard - my heart starts racing near the end as I feel that the last 15 minutes of fussing can make the difference between a good and great result. That is why I have never been afraid to operate on my friends, staff and family – I always get very good results with these people, and I wouldn’t operate on them unless I KNEW they were good candidates. That is what makes it harder with other patients – just like in a marriage, it takes a long time to get to know a patient, and I have to rely on my judgement as to whether they will really be a good patient, listen, be honest, have a support system at home, – basically, tell you the truth about what is going on with them. That is also why I love to do second, third, and fourth procedures down the road on my good patients – you know them, by that time, like family, and communication is so easy; for the surgeon, it’s just a matter of deciding what to do, and executing well. Just like Peyton Manning and his favorite receiver.
Radiance Plastic Surgery
Main Office:
701 Boyce Road
at Washington Pike
Bridgeville, Pennsylvania 15017
Ph: (866) 660-0017
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McKees Rocks, Pennsylvania 15136
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